| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
601 |
599 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
779 |
715 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
299 |
$19K |
| D0274 |
Bitewings - four radiographic images |
602 |
588 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
115 |
114 |
$9K |
| D1110 |
Prophylaxis - adult |
126 |
125 |
$5K |
| D0330 |
Panoramic radiographic image |
106 |
104 |
$3K |
| D1120 |
Prophylaxis - child |
256 |
251 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
21 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
139 |
71 |
$1K |
| D1206 |
Topical application of fluoride varnish |
261 |
261 |
$939.79 |
| D0272 |
Bitewings - two radiographic images |
72 |
72 |
$0.00 |